Healthcare Provider Details

I. General information

NPI: 1003265885
Provider Name (Legal Business Name): JENNINE LENORE PUTNICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 OAKLEY SEAVER DR STE A
CLERMONT FL
34711-1925
US

IV. Provider business mailing address

1804 OAKLEY SEAVER DR STE A
CLERMONT FL
34711-1925
US

V. Phone/Fax

Practice location:
  • Phone: 407-521-3620
  • Fax: 407-521-3621
Mailing address:
  • Phone: 407-521-3620
  • Fax: 407-521-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME169972
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number268511
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: